Women In Plastic Surgery Research Articles

Evaluating the Paucity of Female Surgeons in Plastic Surgery: A Review of the Systemic Barriers to Entry and Success.

The percentage of practicing female plastic surgeons in the United States is notably low. This narrative review sought to identify prominent barriers affecting women's entry and success in plastic surgery. A literature search was conducted using the National Library of Medicine from 2013 to 2023, using MeSH terms of gender disparity and plastic surgery. Included publications were peer-reviewed articles and systematic reviews evaluating gender disparity in plastic surgery, examining experiences, challenges, or opportunities for female plastic surgeons. Excluded publications did not include data gathered from the United States, included other minorities, or did not focus on plastic surgery. Overall, 191 papers were identified, with 14 papers being selected for this review. Early barriers identified before residency training include the lack of female mentors and the underrepresentation of female presenters at national plastic surgery conferences, with females comprising only 29% of presenters and 16% of abstract senior authors at national plastic surgery conferences between 2014 and 2015. During residency training, the most prominent barrier is pregnancy, with 73% of women delaying childbearing during residency and only 39% of men reporting the same. A second barrier during training includes gender disparity in the number of research publications, with females publishing 8.89 ± 0.97 publications during residency and males publishing 12.46 ± 1.08 publications (p = 0.0394). After residency training, evidence of barriers to career advancement includes poor representation of women in higher academic positions, such as program chairs and directors, with female representation of 9.2% and 13.1%, respectively, and gender disparity in industry payments. Systemic barriers before, during, and after plastic surgery residency training seem to influence the representation of women in plastic surgery at all levels. These barriers should be addressed to increase the number of practicing female plastic surgeons and diversify the field.

Can State Family Support Policies Level the Playing Field for Early-Career Women in Plastic Surgery? An Analysis of Web-Scraped Data.

For the young plastic surgeon, the quantity of first-author peer-reviewed publications plays a prominent role in job offers and promotions. Women surgeons carry a disproportionate share of family responsibilities, contributing to their lower representation in positions of leader- ship and influence. Policies protecting reproductive rights and mandating paid family leave (PFL) boost women's participation and productivity in the workplace. However, these policies vary by U.S., state and territory. Web-scraped publication data from all PubMed-indexed plastic surgery journals from 2010 to 2022 were evaluated by first-author gender and affiliated state reproductive rights policy and PFL. Female first authors were further compared with men by publication output (1 article; ≥ 2; ≥ 5) by gender and by affiliated state policies. Protective reproductive rights policies were associated with greater representation of female first authors (3.3 percentage points; p value = 0.003). Protective reproductive rights policies and PFL were associated with a decreased publication gender gap (0.13 articles, p value < 0.001, and 0.18 articles, p value < 0.001, respectively). Protective reproductive policies and PFL had an even greater correlation with higher publication output among female first authors. Protective reproductive rights and mandatory PFL are not only correlated with women's representation among early-career researchers but with a reduction in the publication gender gap. Legislation and policies aimed at supporting women's family responsibilities are associated with higher research productivity among women and likely play a significant role in attracting more women to higher academic ranks and improving gender equity in professional success in plastic surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Utilizing Relative Citation Ratio to Compare Academic Productivity by Gender in Plastic Surgery

IntroductionThe relative citation ratio (RCR) is a bibliometric index utilized to assess research productivity. Mean relative citation ratio (m-RCR) and weighted relative citation ratio (w-RCR) can be utilized to assess individual research quality as well as career-long productivity, respectively. We sought to determine differences in academic productivity between genders and identify demographic variables associated with increased academic productivity. MethodsA list of Plastic and Reconstructive Surgery residency programs was compiled utilizing the American Council of Academic Plastic Surgeons website. Each program department's website was utilized to generate a list of practicing surgeons and respective demographic information. Both mean and weighted RCR were obtained using the iCite, a National Institutes of Health bibliometric tool. Surgeons were excluded if any demographic or RCR data was not accessible. Chi-squared test, Mann–Whitney U test, Kruskal–Wallis test, and multivariable linear regressions were performed. ResultsA total of 785 academic plastic surgeons met the criteria and were included in the analysis, 186 of whom were women and 599 men. Both academic rank and model of residency training were significantly associated with gender in chi-squared analysis (P < 0.05). Mean relative citation ratio was higher among men in departments. Mean w-RCR was higher among men of assistant professor status, chief/chairperson status, integrated model of residency training, faculty size ≥six and in departments and divisions. Academic rank and faculty size were associated with higher w-RCR upon multivariable linear regression. ConclusionsAlthough differences exist in mean w-RCR between men and women in plastic surgery, gender is not a predictor of increased academic productivity. RCR is an accurate means of assessing gender differences in academic productivity as it comprehensively considers both quality and quantity of research and may be superior to other, older bibliometric indices.

Gender Differences in Plastic Surgery Trainee Confidence: A Pilot Analysis During Cleft Lip Simulation

Background: Underrepresentation of women in plastic surgery remains a concern. This study investigates gender-related differences in self-confidence and surgical ability among plastic surgery trainees in an effort to work toward gender parity. Methods: Residents and fellows were recorded performing up to three cleft lip repairs on a high-fidelity simulator. Demographic information was collected, and two questionnaires were completed to assess self-confidence after each simulation. Videos were rated blindly using the objective structured assessment of technical skills and unilateral cleft lip repair competency assessment tool. Differences between participants were estimated using generalized estimating equations modeling, and correlation between overall self-confidence and performance was examined using Pearson correlation (r). Results: Twenty-six participants (six self-identified women and 20 self-identified men) completed 73 simulated procedures. There was no gender-related difference in training level, volume of prior experience, speed with which participants completed each simulated procedure, or objective performance. However, a significant difference was found in overall procedural self-confidence, with women rating their confidence lower (mean = 16.9, SD = 4.3) than men (mean = 19.4, SD = 3.8); P = 0.021. Further analysis revealed that confidence scores correlated more strongly with objective performance for women (r = 0.83) than for men (r = 0.45). Conclusions: Women plastic surgery trainees overall reported lower self-confidence than their male counterparts, despite demonstrating at least as much skill. Confidence and skill were more closely related for women, suggesting that mentorship focused on concrete skill building may help close the confidence gap.

Early Women Pioneers and the Evolution of Women in Plastic Surgery.

The history of women in surgery has been documented since ancient times. Despite this, women physicians have historically encountered unique obstacles in achieving the same respect and privileges as their male counterparts. Early female physicians overcame many challenges to complete their training following graduation from medical school. The first woman in the field of plastic surgery in the United States was Dr. Alma Dea Morani, who became a member of the American Society of Plastic and Reconstructive Surgeons (ASPRS, now ASPS) in 1948. She applied for plastic surgery training six different times over 6 years, until she was accepted at a position where she had shadowing-only privileges. Yet, her steadfast determination and perseverance led her to build a successful career, becoming a role model and advocate for women in plastic surgery. The Women Plastic Surgeons Forum within ASPRS was officially established in 1992; however, informal events began as early as 1979. This group fostered mentorship among emerging female leaders, allowing women to take on leadership roles within national plastic surgery organizations. These women, in turn, have become role models for subsequent generations of women in this field. Plastic surgery has historically seen a higher percentage of female residents relative to other surgical specialties. Studies have shown that female role models are the most influential factor for female medical students interested in plastic surgery, a powerful fact considering women now comprise over 50% of graduating medical students. Female mentorship is essential in fostering the future generation of female plastic surgeons.

The Status of the Plastic Surgery Workforce for Women and Recommendations on How to Be Successful

Abstract Goals/Purpose The status of women in medicine has been rapidly evolving. Recent data shows that women now make up the majority of current medical students in the United States. Women now constitute 40.5% of integrated plastic surgery residents and make up 20% of the current plastic surgery workforce. The evolving face of the plastic surgery workforce warrants a deeper look at where we stand today. There has been literature published in recent years looking at women plastic surgeons in academia but little attention has been paid to the greater female plastic surgery workforce to include those in other practice settings. The purpose of this study is to look at current practices for female plastic surgeons, paths taken to get there, and advice for young female surgeons and surgical trainees. We aim to characterize and project future trends of the status of women in plastic surgery. We further outline recommendations on how to be successful as a female entering the field. Methods/Technique A survey was created using Survey Monkey with a series of 37 questions. These questions focused on demographics, what practices currently look like, paths taken to get there, individual desires for practice changes, and advice for female plastic surgeons early in their career. Email addresses were obtained through a web-based search using both the American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons listed board-certified female plastic surgeon members in the United States. A total of 748 surveys were emailed and survey responses were collected. Results/Complications There was a total response rate of 33%. Most respondents trained in an integrated pathway program (54%) and did not complete a fellowship (37.7%). The majority practice in a large city (44.6%), work 40-60 hours per week (63.4%) and perform 20-30 cases per month (34.05%). Most respondents work in a solo practice (32.05%). For those that previously worked in a different practice setting, the most common prior settings were small group practice (36.89%) and academia (32.04%). Fifty six percent of women did not have a female mentor. The majority of respondents are very satisfied in their current career (54.63%). The factors that ranked highest for helping women achieve success were persistence (81.14%), patient care (76.75%), patient rapport/communication (77.19%) and grit (74.89%). The highest ranked barrier to success included discrimination as a female (17.18%), lack of mentorship (16.81%), and personal/family demands (16.74%). Recommendations for women pursuing a career in private practice included starting to learn to run a business in residency/fellowship and get additional business education, finding a mentor, and to start growing your social media platform during training. Conclusion The plastic surgery workforce for women continues to evolve. Most practicing female plastic surgeons recommend for trainees to start learning how to run a business during their training and acquire additional business education. In addition, they stress the importance of mentorship throughout this process. As more women continue to enter the field of plastic surgery, mentorship and support for childcare to help with family demands will be paramount to their success. Residency programs should consider incorporating more business training into their curriculum given the majority of trainees will go on to work in a private practice setting.

A New Decade for Diversity: Trends in Representation of Women at the Northeastern Society of Plastic Surgeons.

In 2018, the Northeastern Society of Plastic Surgeons first Women in Plastic Surgery was established, reflecting the national trend to address the gender gap between men and women in surgery. Conferences, such as the annual NESPS, are important opportunities to increase visibility of female role models and resources to address deterrents to surgical careers. We thus sought to examine the participation and visibility of women in the NESPS over the last decade. Abstracts and programs from the NESPS regional conferences between 2013 and 2019 were accessed via the publicly available past meetings archives, and registration lists were provided by the NESPS. Registrants, panelists, speakers, moderators, and first author and senior author listed for each poster presentation, podium presentation was listed, sex was determined (male or female), and sex were aggregated by category of participation. Significance was set at a P value of less than 0.05. Registration of women for the NESPS annual conferences was constant for 5 years (2013-2017), followed by an increase in female registrants from 27.1% in 2017 to 42.3% in 2019. Female representation among poster and podium presentations also increased from 2017 to 2019 (7.7%-23.3% poster presentations and 11.1%-23.4% podium presentations). Invited positions (speakers, panelists, and moderators) had a peak of 32.2% in 2017, but otherwise, there is no clear evidence of improved representation of women. We found an increase in the proportion of female registrants at the annual NESPS conferences from 2013 to 2019. However, visibility of female participants fluctuated over the same period; addressing this represents one opportunity for closing the gender gap at the NESPS. As the percentage of female trainees continues to rise, we look to female faculty to continue to participate in educational events, such as the NESPS meeting, and to be present as role models for the growing new generation of female plastic surgeons.

Women in Cosmetic Plastic Surgery: An Analysis of Female Authorship in Cosmetic Plastic Surgery Over the Last 10 Years

There is a significant gender gap in research conducted by women in plastic surgery. Previous work has not explored female authorship trends in cosmetic plastic surgery. We asked how authorship trends in cosmetic plastic surgery compare with those in plastic surgery overall, over the last 10 years. All the articles published in Journal of Plastic Reconstructive and Aesthetic Surgery (JPRAS), Facial Plastic Surgery and Aesthetic Medicine (JAMA facial plastics), and Aesthetic Surgery Journal. (ASJ) in 2009, 2014, and 2019 were retrieved. The gender of the first and last author was determined. In addition, article type and total number of authors were extracted. Chi-square or Fisher exact test were performed to determine differences between groups Linear regression models were used to investigate whether total number of authors, or female last authorship predicted female first authorship. A total of 4358 articles were reviewed. Of these, 16.6% (n = 723) were published by a female first and/or last author. Percent of female first and/or last author increased with time, from only 12.2% in 2008, to 15.9% in 2014, reaching 21.7% in 2019. A total of 25% (n = 181) of randomized controlled trials were published by a female first and/or last author compared with only 14% (n = 440) of case studies. Female first and last authorship both increased across the 10-year study period, but there were consistently more female first authors than female last authors in all 3 surveyed years ( P &lt; .001). There was an 86% increased chance of female first authorship if the last author was also female ( P &lt; .001), and a 7% increased likelihood of female first authorship ( P = .002). Women have a lower representation in the cosmetic plastic surgery literature than men. This gender disparity gap, however, is decreasing. While encouraging, opportunities for improvement remain.

The confidence gap: Findings for women in plastic surgery

BackgroundIn a surgical field, where surgeons are, “sometimes wrong, but never in doubt,” lack of confidence can have detrimental effects on career advancement. In other fields there is evidence that a gap exists between women and men in the amount of confidence they display, and that confidence is a proxy for success. MethodsThis study used the General Self Efficacy Scale and Rosenberg Self-Esteem Scale confidence surveys to assess self confidence amongst female trainees and attending plastic surgeons, to search for baseline characteristics associated with higher confidence scores. ResultsOf the 73 participants, protective factors associated with increased female plastic surgeon confidence include age, parity, more advanced academic status, and mentorship. ConclusionsIn order to matriculate into a surgical training program, there must be a measure of confidence and resiliency, but further work needs to be done to identify and address gender gaps in training and early academic careers.

A Report on the Representation of Women in Academic Plastic Surgery Leadership.

The year 2017 marked the first year women comprised a majority of U.S. medical school matriculants. While more women are pursuing surgical training, within plastic surgery, there is a steady attrition of women advancing in leadership roles. The authors report the current status of women in academic plastic surgery, from trainees to chairwomen and national leadership positions. The Electronic Residency Applications Service, San Francisco Match, National Resident Matching Program, Association of American Medical Colleges, American Council of Academic Plastic Surgeons, Plastic Surgery Education Network, and professional websites for journals and national societies were accessed for demographic information from 2007 to 2017. The number of female integrated pathway applicants remained stable (30 percent), with an increased proportion of female residents from 30 percent to 40 percent. There was an increase in female faculty members from 14.6 percent to 22.0 percent, an increase of less than 1 percent per year. Twelve percent of program directors and 8.7 percent of department heads were women. Nationally, major professional societies and administrative boards demonstrated a proportion of female members ranging from 19 percent to 55 percent (average, 27.7 percent). The proportion of female committee leaders ranged from 0 percent to 50 percent (average, 21.5 percent). Only six societies have had female presidents. No major journal had had a female editor-in-chief. The proportion of female editorial board members ranged from 1 percent to 33 percent (average, 16.1 percent). The authors' study shows a leak in the pipeline at all levels, from trainees to faculty to leadership on the national stage. This report serves as a starting point for investigating reasons for the underrepresentation of talented women in plastic surgery leadership.

Commentary on: The Leaky Pipeline of Women in Plastic Surgery: Embracing Diversity to Close the Gender Disparity Gap.

Commentary on: The Leaky Pipeline of Women in Plastic Surgery: Embracing Diversity to Close the Gender Disparity Gap.

Commentary on: The Leaky Pipeline of Women in Plastic Surgery: Embracing Diversity to Close the Gender Disparity Gap.

Commentary on: The Leaky Pipeline of Women in Plastic Surgery: Embracing Diversity to Close the Gender Disparity Gap.

The Leaky Pipeline of Women in Plastic Surgery: Embracing Diversity to Close the Gender Disparity Gap

The Balance for Better campaign theme of the 2019 International Women's Day prompted a closer look at diversity within the plastic surgery specialty. Gender balance in the United States has improved through many organizational efforts and enactment of laws. Unfortunately, despite these endeavors, statistics show that men still enjoy greater financial and career success. Within the field of medicine, a similar trend has been observed. Although women constitute 50% of medical school graduates, the majority still enter fields outside of surgical subspecialties. In comparison to other surgical subspecialties, women are most represented in plastic surgery. Unfortunately, significant gender discrepancies remain in postgraduate practice including academic practice rank, societal board membership, invited speaker opportunities, and compensation, to name a few. The "leaky pipeline" of women describes the precipitous decline in the numbers of women at each step up the professional ladder. We explore the multifaceted nature of this phenomenon and highlight factors that contribute to limiting female growth within the plastic surgery profession. We also emphasize the continued growth of female plastic surgeon presence in all sectors despite these existing obstacles. We submit that continued leadership, mentorship, and sponsorship provided by both male and female physicians in the field will facilitate future leadership, advance gender parity, and cultivate a sense of belonging within the plastic surgery community, allowing brilliant minds to flourish and the profession to thrive.

Abstract 40: Leadership in Academic Plastic Surgery: Current Representation of Women

PURPOSE: 2017 marked the first year women comprised a majority of United States medical school matriculants. While more women are pursuing surgical training, within plastic surgery, there is a steady attrition of women advancing in academics and leadership. We aim to report the current status of women in academic plastic surgery, from trainees to chairwomen and national leadership positions. METHODS: ERAS,SF match, NRMP, AAMC, ACAPS, PSEN, and professional websites for journals and national societies were accessed or contacted for demographic information for the last decade. RESULTS: At the trainee level, in the integrated applicant pathway, the number of female applicants has remained relatively stable, at around 30%, but the proportion of female residents has increased, from 30% to 40%. In the independent pathway, the proportion of female applicants and residents has remained relatively stable, with three men to every woman. At the faculty level, from 2006 to 2016, there was an increase in female faculty members from 14.6% to 22.0%, an increase of <1% per year. Twelve percent of program directors are currently female, and 8.7% of department heads. Nationally, major professional societies and administrative boards were evaluated, including ASPS, ABPS, and the residency accreditation committee. For all committees, the proportion of female members ranged from 19% to 55%, with an average of 27.6%. For committee leaders, the proportion of women ranged from 0% to 50%, with an average of 21.5%. Presidents of these societies were historically led by men, with only six having a history of female presidents. Major journals were evaluated for composition of editorial boards. No journals had a female Editor-in-Chief. The proportion of female editorial board members ranged from 1% to 33%, with an average of 15.3%. CONCLUSION: Recent literature has shown patients of female physicians to have better outcomes, and even a preference of female patients for female plastic surgeons. However, when it comes to academic leadership, women lag behind. As with other women in surgery, women in plastic surgery share a cumulative career disadvantage (personal, networking, clinical, academic, etc). Upward mobility is a challenge, as is recruitment and retention. Our study shows a leak in the pipeline at all levels, from trainees to faculty, to leadership on the national stage. This report serves as a starting point for investigating reasons for this loss of talented women in plastic surgery leadership.

Abstract 75: Gender Diversity in Organized Plastic Surgery: Evaluation of Leadership in Societies and Editorial Boards

PURPOSE: Previous literature from 2007 has cited that women represent 11.3% of the leadership positions in plastic surgery societies and journal editorial boards. At the time this was published, only 22% of plastic surgery residents were female. As of the most recent ACGME data, females now comprise 40.5% of integrated plastic surgery residents, showing that the number of women in plastic surgery continues to grow, but no further investigation of the representation of women in these leadership positions has been performed. This study aimed to analyze the trends of gender inequality in leadership of plastic surgery societies and journal editorial boards in the past ten years. METHODS: Names of board members from the major plastic surgery societies (ASPS, PSF, ASAPS, ASMS, ASRM, AAHS, ABPS) for the past ten years were extracted from their websites. Names of board members from the major plastic journals (PRS, Annals of Plastic Surgery, ASJ, JRM, JCF) from the past 5 years were extracted from their websites. The yearly percentage of female plastic surgery residents was obtained from ACGME published data. The proportions of female society leadership and female editorial board members, and percentage of female residents were compared with data analyses of time series trend and linear and ARIMA time series modeling. RESULTS: Over the past 10 years, the percentage of female residents across both independent and integrated programs has grown steadily from 21.84% to 37.31%. Similarly, female representation in society leadership has grown steadily from 6.78% to 20.29%. Both growth coefficients were statistically significant and when comparing the two showed no statistical difference. In contrast, editorial board leadership over the past 5 years has shown relatively flat growth, with the percentage of females hovering around 10% until 2018 when it increased to 12%. The modeled growth coefficient of the female percentage of editorial boards was statistically insignificant and showed a statistically significant difference when compared to the growth of the percentage of female residents and female representation on society leadership. CONCLUSION: Female representation in plastic surgery residencies and plastic surgery society leadership has grown significantly and at a similar rate. Currently both absolute percentages sit well above the current percentage of female ABPS members of 15%, which is promising for female growth in the field. In contrast, female representation in editorial boards showed significantly less growth, which may reflect the slower turnover of their members.

Gender Inequality for Women in Plastic Surgery: A Systematic Scoping Review.

Previous research has highlighted the gender-based disparities present throughout the field of surgery. This study aims to evaluate the breadth of the issues facing women in plastic surgery, worldwide. A systematic scoping review was undertaken from October of 2016 to January of 2017, with no restrictions on date or language. A narrative synthesis of the literature according to themed issues was developed, together with a summary of relevant numeric data. From the 2247 articles identified, 55 articles were included in the analysis. The majority of articles were published from the United States. Eight themes were identified, as follows: (1) workforce figures; (2) gender bias and discrimination; (3) leadership and academia; (4) mentorship and role models; (5) pregnancy, parenting, and childcare; (6) relationships, work-life balance, and professional satisfaction; (7) patient/public preference; and (8) retirement and financial planning. Despite improvement in numbers over time, women plastic surgeons continue to be underrepresented in the United States, Canada, and Europe, with prevalence ranging from 14 to 25.7 percent. Academic plastic surgeons are less frequently female than male, and women academic plastic surgeons score less favorably when outcomes of academic success are evaluated. Finally, there has been a shift away from overt discrimination toward a more ingrained, implicit bias, and most published cases of bias and discrimination are in association with pregnancy. The first step toward addressing the issues facing women plastic surgeons is recognition and articulation of the issues. Further research may focus on analyzing geographic variation in the issues and developing appropriate interventions.

Abstract 59. The Evolving Presence of Women in Academic Plastic Surgery: A Study of the Past 40 Years

Purpose: Among surgical subspecialties, plastic surgery holds the highest percentage of women, and the female contingent of board-certified plastic surgeons and trainees has grown steadily in the past decades. Traditionally, women in plastic surgery have been perceived to prioritize private practice models and their academic impact has been underestimated. We present the academic footprint of female plastic surgeons over the past 40 years. Methods: A list of female plastic surgeons currently active at- and retired from- ACGME-accredited plastic surgery residency programs was compiled. Each surgeon was searched on PubMed to gather the total number of publications, journals, and topics of research after completion of training. Date of publication and five-year impact factor for each journal was recorded. Publications were organized into four consecutive 10-year periods (1976–1985, 1986–1995, 1996–2005, 2006–2016). Results: We identified 155 currently active- and 80 retired- academic female plastic surgeons, who published 2,982 articles in 479 peer-reviewed journals with an average 5-year impact factor of 4.093. The number of publications increased with each decade: 37 (1976–1985), 218 (1986–1995), 472 (1996–2005), 2,255 (2006–2016). The most commonly published areas were hand/nerve (22%), craniofacial (21%) and breast (20%). Over time, publications in hand/nerve research decreased (76%, 60%, 38%, 14%); craniofacial-related publications increased (8%, 11%, 18%, 23%); breast research increased (0%, 8%, 9%, 24%). The 2006–2016 period yielded the most even distribution of research topics. Conclusion: In the past four decades, the academic contribution of female plastic surgeons has substantially increased in number and have become more evenly distributed across subspecialty topics.

Striking a Better Integration of Work and Life: Challenges and Solutions.

Plastic surgeons are a diverse group but share a drive for excellence and dedication to their patients and the advancement of the specialty. Long hours at work and the need to be on call have limited the time that many have to spend on activities outside of the workplace. Reconciliation of the demands of surgery and private life can at times seem impossible. A failure to achieve balance between work and home life is associated with reduced job and life satisfaction, impaired mental health, family conflict, and ultimately burnout. Although the obstacles are many and varied, the authors have attempted to identify the challenges and propose solutions. The authors focus on women in plastic surgery in this article, but acknowledge that these issues are not unique to women or plastic surgery.

Reflections on the Mating Pool for Women in Plastic Surgery

Almost three times as many board-certified female plastic surgeons are unmarried compared with male colleagues. The purpose of this study was to determine why women in plastic surgery are less likely to be married. A 52-question survey was sent to all female members of the American Society of Plastic Surgeons. Questions focused on type of training and practice; marital status; age at marriage; spousal education, financial, and professional status; relational goals, values, and satisfaction. A total of 729 questionnaires were sent via e-mail; responses were anonymous. Response rate was 34 percent (n = 250). Respondents were either married (64 percent), engaged (2 percent), in a "serious" relationship (11 percent), or not in a committed relationship (23 percent). Of unmarried respondents, 56 percent wanted to marry, 44 percent did not wish marriage at the time of the survey, and 42 percent had deliberatively postponed marriage. The most frequently cited reasons for being single were perceived lack of desirable partners (45 percent), job constraints (14 percent), and personality differences (13 percent). Female plastic surgeons who married later than 36 years of age were more likely to choose a spouse with a lower income, less education, and lower financial success compared with female plastic surgeons who married at a younger age. Women in surgical practice who marry later are less likely to find a partner with equal educational level, financial resources, and professional success. Hence, a shift occurs from hypergamy toward hypogamy. These findings are not unique to plastic surgery.